Middlesex Health Family Medicine Residency

Kimberly Legere-Sharples, MD, MSMEd, FAAFP, Residency Program Director

Yadira Acevedo, MD, FAAFP, On-site Evaluator/Project Lead

Problem Statement:

The traditional, 3-year Family Medicine residency poses significant time constraints given the ever-growing complexity of medicine and individual learner interests

Proposed Solution

A fully integrated, 4-year program, allows for additional learning encounters, an enhanced core-curriculum, and learner flexibility to develop additional areas of interest

Our 4 year Curriculum

Nation’s first comprehensive, mandatory 4 year residency program

Implemented 2007

Enhanced core for all and “track time” for individualization

  • 7 additional core rotations- peds, OB, sports medicine
  • 28 weeks of tracks spread through PGY-3 & 4
  • Emphasis on broad scope, continuity, and clinical volume

94 4-year graduates

Core Experiences

Additional Pediatrics and OB

  • Helps residents develop the confidence necessary to continue this care in practice
  • Counters national trends towards eroding scope of practice

Practice management and systems medicine

  • Allows residents to be successful in practice
  • Adds value to their employers
  • Prepares graduates to become leaders

Tracks of Excellence

  • Pregnancy and Newborn Care
  • Integrative Medicine
  • Academics
  • Global and Community Health
  • Behavioral Medicine
  • Geriatrics and Palliative Medicine
  • Sports Medicine
  • Lifestyle Medicine
  • Personalized

Our Key Measures

  • Applicants per offered position
  • Match rates
  • USMLE Step 2 score of applicants and matched candidates
  • ABFM In-Training and Certification performance
  • Resident attrition rates during training
  • Resident clinical experience volume
  • Resident continuity of care
  • Resident achievement of FM Milestones
  • Resident satisfaction with training
  • Residency community engagement
  • Graduate satisfaction with practice
  • Graduate scope of practice
  • Graduate location of practice
  • Graduate preparation for practice as perceived by both the graduates and their future employer
  • Program financial performance
  • Patient care delivery measures (referral rates, total cost of care, ambulatory sensitive ED visits/hospital admits, and patient experience)

So Far, our 4-year graduates. . .

  • High levels of resident and graduate satisfaction
  • Substantially more clinically confident
  • Choose broader scope practice
  • Use the skills acquired in their tracks in practice
  • In strong demand in employment market

Additional Clinical Volume

  • While competency is important, there is no substitute for substantial clinical experience
  • Our graduates have substantially more than 3 year residents
  • 2600 outpatient encounters
  • 1600 adult inpatient encounters
  • 140 newborn encounters

Expected Impediments

  • Nationwide physician burnout
  • Variation in resident engagement and clarity of goals
  • Maintaining the right balance between core activities and track interests (cake vs. frosting)
Not Enough
Just Right
Too Much

Expected Enablers

  • 17 years of experience being a 4-year program
  • Strong institutional support
  • Specialist commitment to teaching and providing opportunities

Competency Based Medical Education

  • Assess the residents ability to achieve high-level milestones reflecting their progress towards clinical mastery
  • Competency-based skills assessment for procedural training
  • Direct observation and OSCE assessment
  • Given the heterogenous nature of the activities in each resident’s area of concentration, individual learning plans and assessments will be required

Issues Needing Assistance

Developing competency-based evaluation tools

Our Inspiration

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